【摘要】 目的　评价介入微创伤治疗深静脉血栓及其并发症 巨块型肺动脉血栓栓塞的安全性和效果。方法　 11例患者均用介入治疗。 6例合并肺动脉血栓栓塞 ,其中 4例为急性巨块型。确诊方法主要有胸部增强CT、下肢 盆腔Doppler超声波检查和血管造影。所应用的介入治疗技术有经导管血栓抽吸、捣碎 (n =11) ,保留导管溶栓 (n =7) ,下腔静脉过滤器置入 (n =11)和金属支架开通髂静脉阻塞 (n =4)。术后给予肝素和低剂量溶栓治疗 1周 ,以后改为长期口服抗凝剂。术后随访内容有超声波、胸部X线片、部分患者做增强CT ,随访时间 6～ 2 2个月。结果　① 7例左侧下肢深静脉血栓、4例右侧 ,进行介入治疗 9例 ,血栓抽吸、溶栓和髂静脉支架置入的技术成功率为 10 0 % ,临床有效率为 10 0 % ,无重要并发症 ;②下腔静脉过滤器置入成功率为 10 0 % ,随访期间未出现肺栓塞症状 ;③合并肺动脉血栓栓塞 6例 ,4例为中央巨块型栓塞、均有右肺动脉主干及其分支受累及 ,3例合并有左下肺动脉栓塞 ,累计梗塞范围约 5 5 %～ 75 % ,动脉血氧分压均低于正常 ( 75～85mmHg) ,介入治疗后临床症状和复查血管造影均有明显改善。结论　介入技术是治疗下肢深静脉血栓的安全、有效方法 ;下腔静脉过滤器置入可预防致命性肺动脉血栓栓塞 ;经导管血栓清?更多还原

【Abstract】 Objective To assess the efficacy and safety of the interventional techniques for treatment of deep venous thrombosis (DVT) and acute massive pulmonary thromboembolism (PTE). Methods Eleven patients with DVT were treated with interventional techniques. Six of them presented with PTE,4 presented with massive PET. Thoracic contrast enhancement CT,Doppler ultrasonography,and venography were performed in the patients. The interventional procedures were included catheter fragmentation and suction in 11,catheter directed thrombolysis in 7,the IVC filter placement in 11,and stent placement in 4. Low dose of urokinase and heparin were given for one week after the procedures. Follow up study consisted of chest X ray,CT,and ultrsound examination. Results Technical success was achieved in all cases. There was no significant complication. The DVT related symptoms were relieved in all treated patients. In the 4 patients with massive PTE,thrombus removal with flow restoration were observed on the pulmonary arteriography. Clinical improvement was observed in the 4 patients. Systemic arterial oxygen saturation improved from a mean of 80% before the treatment to 94% after the procedures. Pulmonary arterial pressure decreased from a mean of 46mmHg before the treatment to 38mmHg after the procedures. Conclusion Catheter directed mechanical fragmentation,suction,and thrombolysis are safe and effective in the treatment of DVT and acute massive PTE with hemodynamic impairment. IVC filters may be a useful technique for the prevention of PTE.更多还原